层面递进法激光腔内剜除高危前列腺增生的治疗体会

目的探讨1 470 nm激光剜除治疗高危前列腺增生的手术技巧及临床效果。 方法回顾分析2018年6月至2018年9月中山大学附属第三医院泌尿外科采用1 470 nm激光治疗共89例高危前列腺增生患者的临床资料，年龄平均（68±3）岁，前列腺体积（57.4±2.6）ml。所有患者均采用"寻找层面，先易后难，剜切结合"的层面递进法思路行激光腔内前列腺剜除术，比较患者术中及术后情况。 结果89例均顺利完成手术，与术前相比，术后3个月患者最大尿流率明显增加，[（6.9±2.1） ml/s vs（19.8±3.6） ml/s]。国际前列腺症状评分显著好转，[（24.6±1.7） vs（8.0±1.2）]。术中无输血、无电切综合征、无直肠和膀胱穿孔病例，无输尿管损伤、大出血、心脑血管意外等严重并发症发生。 结论层面递进法激光剜除技术构想对于高危前列腺增生外科包膜层面的寻找、减少术后并发症有独到优势，且易于掌握，或可为业界同行提供一个新的思路。     

高敏受者肾移植术前行血浆置换的临床探讨

目的 :探讨高敏受者肾移植术前行血浆置换 (PE)的效果。方法 :12例高敏受者在肾移植术前进行PE治疗 ,37例高敏受者未行PE治疗 ,观察两组肾移植病人排斥反应发生率的差异。结果 :PE组置换前PRA值71.0 %± 19.1% ,置换后 34.3%± 17.9% ,两者有显著性差异 (P <0 .0 1)。术后发生超排 2例 ,急性排斥 2例 ;未行PE组发生超排 2例 ,急性排斥 8例 ,两组间超排和急性排斥的发生率均无显著性差异。结论 :PE对预防超排和降低急性排斥的发生率均无明显作用。PE治疗的主要适应症为PRA大于 80 %的受者 ,能快速降低PRA值 ,有助于HLA抗体特异性分析和HLA配型。     

丹参对大鼠肝细胞凋亡及相关基因表达的影响

目的 :探讨丹参对大鼠肝脏缺血再灌注时肝细胞凋亡及相关基因 (Bcl-2和 Bax)表达的作用。方法 :SD大鼠随机分为假手术 (SO)组、缺血再灌注 (IP)组及丹参 (SM)治疗组 ,并根据再灌注不同时间点再分为 7个亚组。后 2组缺血时间均为 30 min。分别于再灌注 0、1、6、12、2 4、48、72 h后采取肝脏组织标本。分别采用原位末端标记 (TU NEL)技术和免疫组化 ,检测大鼠肝组织细胞凋亡及 Bcl-2、Bax蛋白表达水平。结果 :缺血再灌注组细胞凋亡 1h开始出现 ,12～ 2 4h达峰值 ,Bcl-2、Bax的表达增强 ;2 4h后凋亡峰缓慢下降 ,Bcl-2、Bax的表达陆续减弱。丹参治疗组与缺血再灌注组相比于 1～ 72 h各时间点 Bcl-2表达增强 ,Bax表达减弱 ,凋亡细胞数明显减少 (P<0 .0 5 ,P<0 .0 1)。结论 :丹参可通过增强 Bcl-2表达 ,抑制 Bax表达 ,而抑制肝脏缺血再灌注时肝细胞凋亡。因而可以预防肝脏缺血再灌注损伤。     

住院医师规范化培训与临床实习并轨模式下临床实习生满意度调查

目的　通过开展住院医师规范化培训与临床实习并轨模式下临床实习生对科室和带教教师的满意度调查,探求如何进一步推进临床实习工作。方法　采用整群抽样方式,自行设计量表,量表内容包括：教学工作重视程度、实习安排合理性、教学活动开展情况、教学活动开展质量、出科考核情况、带教教师医德医风示范性、教师带教态度及教师理论知识的传授情况、教师指导医疗操作情况、教师病历修改情况等。对2018年7月至2019年6月某医院临床专业实习生开展问卷调查。采用SPSS 22.0进行两独立样本的t检验或秩和检验方法,多组数据分析采用方差分析。结果　共发放调查问卷1 230份,收回1 195份,有效回收率97.15%。该医院临床实习生总体满意度为（9.62±0.39）分。实习生对带教教师医德医风示范性的评价最高[（9.75±0.78）分],对各科室教学活动开展质量的评价最低[（9.52±1.15）分],各项评价之间差异有统计学意义（F=7.30,P<0.001）。结论　各教研室、各科室在医院推行住院医师规范化培训与临床实习并轨模式下,按要求完成各项带教任务,但教学质量和内涵建设有待加强。     

超氧自由基和血液粘度的相关性研究

本文对69名体检人员进行过氧化脂质(LPO)血液流变性和血脂检测,应用电子计算机和医用统计软件进行数据分析.直线回归分析表明,LPO与全血和血浆粘度无显著相关;进行多元逐步回归分析表明,LPO在全血粘度比值中则列为第3受选因子,说明LPO对血浆粘度有一定影响.     

~(131)I治疗Graves’病后发生甲低与TGA,TMA及TRAb的关系

目的 :从甲状腺自身免疫方面探讨1 3 1 I治疗甲亢的效果及甲低发生的因素。方法 :选择1 3 1 I治疗的88例Graves’病甲亢患者随访 3年 ,分为第 1组 (TGA、TMA、TRAb均阳性 )和第二组 (TGA、TMA阴性 ,TRAb阳性 )。采用x2 分析自身抗体水平与甲低发生的关系。结果 :1组甲低发生率为 31 4 % ,2组为 3 8% ,1组明显高于 2组 ,差异有显著性。结论 :TGA、TMA和TRAb水平与确定1 3 1 I剂量及甲低的发生关系密切。认为TGA、TMA水平高的患者应酌情减少1 3 1 I用量     

枳实-白术调节PINK1/Parkin信号通路介导的线粒体自噬改善慢传输型便秘大鼠结肠动力障碍

目的：基于线粒体自噬及磷酸酶及张力蛋白同源物诱导的蛋白激酶1(PINK1)/帕金蛋白(Parkin)通路观察枳实、白术及其配伍对慢传输型便秘大鼠结肠动力障碍的改善作用,为临床精准用药提供理论参考。方法：将56只雄性SD大鼠按体质量随机分成正常组、模型组、自然恢复组、枳实组、白术组、枳实-白术组和莫沙必利组,每组各8只。除正常组外,采用洛哌丁胺连续14 d灌胃(3 mg·kg^-1·d^-1)构建慢传输型便秘大鼠模型。造模成功后,除模型组继续洛哌丁胺诱导外,正常组和自然恢复组采用0.9%生理盐水灌胃,枳实组(1.35 g·kg^-1·d^-1)、白术组(2.7 g·kg^-1·d^-1)、枳实-白术组(4.05 g·kg^-1·d^-1)和莫沙必利组(1.56 mg·kg^-1·d^-1)大鼠分别给予相应的药物灌胃,连续7 d。观察药物对大鼠粪便数量、粪便含水率及小肠推进率的影响;苏木素-伊...     

Treatment of Distal Metaphyseal Tibial Fractures with Anterolateral Plates or with Anterolateral-Medial Plates: A Retrospective Series

Distal metaphyseal tibial fractures (3-5 cm from the joint with zones of comminution or <3 cm from the joint) are challenging to fix and are associated with many complications. The study objective was to evaluate the functional outcomes and complications after treating distal metaphyseal tibial fractures using anatomical anterolateral tibia locking plates or anterolateral-medial plates. This retrospective study included 57 patients with distal metaphyseal tibial fractures. Thirty patients were treated by open reduction internal fixation with anterolateral plates; 27 patients were treated with anterolateral-medial plates. Patients were followed at regular intervals. The time to fracture union and complications were recorded. We evaluated the stage of fracture healing using the Radiographic Union Score for Tibial fractures. The patients treated with anterolateral plates had significantly higher rates of loss of reduction and malunion than those treated with anterolateral-medial plates (p = .02 and p = .002, respectively). There were no significant differences in the radiographic union scores (p = .22), non-union (p = .17), incision necrosis (p = .91), or infection (p = .94) between the 2 groups. The functional outcomes were assessed using the American Orthopedic Foot and Ankle Society hindfoot-ankle score at the 12-month follow-up. The mean hindfoot-ankle scores were 90.9 ± 5.0 (range 79 to 100, median 90) and 92.3 ± 5.1 (range 82 to 100, median 92) for the anterolateral plates and anterolateral-medial plates, respectively (p = .29). For distal metaphyseal tibial fractures, anterolateral-medial plates may be worthwhile for reducing loss of reduction and malunion.     

全球针对家族史高危人群的结直肠癌筛查指南推荐意见的系统综述

目的 对全球现有结直肠癌家族史高危人群筛查指南的更新进展及推荐意见进行系统总结和评价。方法 以“结直肠癌”“筛查”“指南”“共识”“推荐”“家族史”以及“colorectal cancer”“screening”“guideline”“recommendation”“family history”为关键词,并补充其自由词,系统检索中国知网、万方数据知识服务平台、PubMed、Embase、Cochrane Library、Web of Science,并且同时检索官网刊登的结直肠癌筛查指南/共识作为补充,语种限定为中文和英文。截至2022年5月24日,共20篇有效文献。对纳入文献的基本信息、针对家族史人群的推荐意见等进行摘录整理及汇总描述。结果 在20篇文献中,大多数国家/地区/机构根据结直肠癌家族史人群的亲属关系等级,对筛查起止年龄、筛查方式及筛查周期提出建议。多数指南针对有1例60岁前患结直肠癌一级亲属的人群,推荐筛查起始年龄为40岁或比患病亲属诊断年龄提前10年,推荐的筛查方式多为结肠镜。结论 目前全球多数结直肠癌家族史高危人群筛查指南主要针对一级亲属家族史、以结肠镜作为主要筛查方式。本文将为我国针对结直肠癌家族史高危人群筛查策略的更新提供参考依据,进而完善结直肠癌筛查与早诊早治实践。     

Essential roles for angiotensin receptor AT1a in bleomycin-induced apoptosis and lung fibrosis in mice

Apoptosis of alveolar epithelial cells (AECs) has been implicated as a key event in the pathogenesis of lung fibrosis. Recent studies demonstrated a role for the synthesis and binding of angiotensin II to receptor AT1 in the induction of AEC apoptosis by bleomycin (BLEO) and other proapoptotic stimuli. On this basis we hypothesized that BLEO-induced apoptosis and lung fibrosis in mice would be inhibited by the AT1 antagonist losartan (LOS) or by targeted deletion of the AT1 gene. Lung fibrosis was induced by intratracheal administration of BLEO (1 U/kg) to wild-type C57BL/6J mice. Co-administration of LOS abrogated BLEO-induced increases in total lung caspase 3 activity detected 6 hours after in vivo administration and reduced by 57% BLEO-induced caspase 3 activity in blood-depleted lung explants exposed to BLEO ex vivo (both P < 0.05). Co-administration of LOS in vivo reduced DNA fragmentation and immunoreactive caspase 3 (active form) in AECs, measured at 14 days after intratracheal BLEO, by 66% and 74%, respectively (both P < 0.05). LOS also inhibited the accumulation of lung hydroxyproline by 45%. The same three measures of apoptosis and lung fibrosis were reduced by 89%, 85%, and 75%, respectively (all P < 0.01), in mice with a targeted disruption of the AT1a receptor gene (C57BL/6J-Agtr1a(tm1Unc)). These data indicate an essential role for angiotensin receptor AT1a in the pathogenesis of BLEO-induced lung fibrosis in mice and suggest that AT1 receptor signaling is required for BLEO-induced apoptosis of AECs in mice as it is in rat and human AECs.